Successful Motherhood After a Kidney Transplant

Successful pregnancy in kidney transplant recipients is not uncommon and worldwide about 12000 such cases have been reported. A reasonably good graft function is a prerequisite. Immunosuppressive medications must be continued throughout the pregnancy period, however safety of some of these agents is not well documented. We report successful pregnancy in one of our patients who had undergone kidney transplantation in Wockhardt Hospital & Kidney Institute four years back. To our knowledge this is the first such instance in Eastern India.

A patient of 26 years old, presented to us in July 2002 with hypertension, swelling and pallor. Investigations revealed elevated Creatinine (2.5mg %), albuminuria, microscopic hematuria. Ultrasound showed echogenic small kidneys. ANA, ANCA were negative. She was diagnosed to have Chronic Kidney Disease presumably due to glomerulonephritis. Renal biopsy was not done for confirmation as the kidneys were small and it was considered unlikely to be of any major therapeutic benefit. She was treated with antihypertensive, phosphate binders and Erythropoeitin and the family was counseled regarding the prognosis and eventual need of renal replacement therapy.

Conservative management yielded good results initially with improvement of Hb levels and stabilization of renal function. Towards the end of 2003 she again started to feel weak and serum creatinine started rising rapidly reaching values of 6.5mg% by November. The family was again counseled regarding the need for transplantation and her mother (56years) was willing to donate. She underwent preemptive renal transplantation in February 2004.

The graft kidney functioned very well in the initial period. She was on standard triple immunosuppression with Cyclosporine, Azathioprine and steroids. Serum Creatinine stabilized around 1.6mg%. Although slightly high this was attributed to the relatively older kidney of her mother. By the end of 2005 serum creatinine started creeping reaching levels of 1.9mg% and there was mild proteinuria. Cyclosporine toxicity/ Chronic Allograft Nephropathy was considered; Cyclosporine dose was reduced and Sirolimus started with improvement of graft function. She was also put on a small dose of Losartan.

In 2006 she was married with the groom fully counseled of her condition and uncertainties regarding pregnancy. They were advised barrier contraception for the time being and it was explained that pregnancy is possible in future after a change in immunosuppression. Losartan is potentially teratogenic and Sirolimus is a relatively new drug with no safety data. In fact it is not recommended in pregnancy.

She presented to us in early August 2007 with a confirmed pregnancy of 6 -7 weeks. Though this was unplanned and attributed to failure of contraception the family was extremely keen to continue as it was felt to be their best chance. Her serum Creatinine was 1.7mg%. Losartan was stopped immediately and Amlodipine was started. Although Sirolimus is not a preferred drug in pregnancy a switchover to other agents would bring in other uncertainties regarding graft function and rejection, and since drug levels were low for some time it was decided to carry on with the same regimen. It was explained that she might have to terminate the pregnancy at the slightest hint of a problem.

Fortunately the entire course of pregnancy was smooth. The normal GFR increase during pregnancy could be seen as the Serum Creatinine dropped to 1.4mg%. Serial USG studies showed normal foetal growth. On 2nd March 2008 a baby girl weighing 2.8 Kg was delivered by Caesarean section. The post operative period was uneventful and she was discharged on the third day.

This case is indeed unique in many ways. She had a preemptive (without long period on dialysis) transplantation from a closest relation (mother) which is the best possible approach. The fact that she was married after transplantation is very encouraging and the role of the society is commendable. Overall the successful pregnancy outcome indicates great progress in the science of renal transplantation and offers new hope to similar couples.

Dr Arup Ratan Dutta
Senior General & Laparoscopic Surgeon
Consultant Nephrologists
Wockhardt Hospital & Kidney Institute
111A, Rashbehari Avenue
Kolkata – 700 029
Ph: +91 33 24633320/19/18/17

Wockhardt Hospitals Kolkata Launches Booklet on "Kidney Treatements"

Wockhardt Hospitals,Kolkata recently released a booklet to generate awareness about kidney ailments, their prevention and getting the correct treatment for Nephrological diseases.

Releasing the booklet How Well Do You Know Your Kidneys? at the Press Club, well known Bengali actress and television personality Sreelekha Mitra said: "I only know drinking a lot of water helps keep our kidneys in good know Shape,I hope this booklet gives me more details. This can be a good guide for those who believe prevention is better than cure."

Each year an additional 1.50 lakh new patients of end-stage chronic kidney disease requiring dialysis or kidney transplant are added to the list of Kidney patients. in India.Out of this only 5 -7 per cent of the patients are able to get some form of treatment, while the rest die without getting any treatement to a study conducted by All-India Institute of Medical Sciences.In India one in ten people has some form of chronic kidney disease. Diabetes and hypertension are responsible for more than 60 per cent cases of chronic kidney diseas

Wockhardt Hospitals,Kolkata will initially print 4,00,000 booklets and distribute them free to patients. It will gradually print the booklet in Bengali and Hindi as well. "Those interested in acquiring a free booklet can contact our hospitals," said Shivaji Basu, Wockhardt's chief urologist.

The eight-page booklet outlines the functions of kidneys in detail, besides listing symptoms of kidney ailments and ways to treat them.